Basal Cell Carcinoma

Basal Cell Carcinoma

David Cassarino, MD, PhD

Clinical photograph of a large facial BCC shows areas of ulceration and granulation-like tissue surrounded by a raised border image. (Courtesy S. Yashar, MD.)

High magnification of a nodular BCC shows a sheet-like proliferation of atypical basaloid cells with high N:C ratios and numerous apoptotic image and mitotic figures image.



  • Basal cell carcinoma (BCC)


  • Basal cell epithelioma (BCE)

  • Trichoblastic carcinoma (not well accepted and should be discouraged)


  • Low-grade malignancy of basaloid-appearing keratinocytes



  • Related to sun exposure (vast majority of cases)

    • Some cases may also be associated with radiation, immunosuppression (organ transplantation), burn scars

      • These cases tend to be more aggressive

  • May actually be derived from follicular stem cells (hence, “trichoblastic carcinoma”)


  • Rare cases are associated with genetic syndromes including nevoid basal cell carcinoma (Gorlin) syndrome, xeroderma pigmentosum, basex syndrome, Rombo syndrome, and McKusick syndrome

    • Genes implicated include PTCH1 (Gorlin syndrome), P53, SOX9, BMI1, BAX, RMRP



  • Incidence

    • Extremely common: Most common cancer in humans when skin cancers are included

      • Accounts for 70% of primary cutaneous malignancies

  • Age

    • Typically older adults; few cases in young adults

      • If in a child, should consider a genetic syndrome

  • Gender

    • Slightly greater incidence in males

  • Ethnicity

    • Caucasian/light-skinned individuals

    • Rare in darker skin types


  • Most common in head and neck region (up to 80% of cases)

    • About 15% occur on trunk and shoulders

    • Very rare cases involve lips, breast, axillae, groin, inguinal region, and genitalia


  • Typically papular, plaque-like, or nodular lesion

    • Often present as a pearly, translucent papule with telangiectasia

    • Larger lesions often ulcerated with bleeding &/or overlying crusting

    • Minority of cases are pigmented, more often in Asians and Africans


  • Surgical approaches

    • Complete excision or electrodessication and curettage (ED&C)

    • Mohs micrographic surgery often used in facial cases


  • Usually excellent, cured by local excision

  • More aggressive subtypes, including micronodular, infiltrative, desmoplastic, and basosquamous, have higher rate of recurrence and increased risk of metastasis

    • Overall risk of metastasis estimated at 0.05%



  • Variable, small (few mm) to large (several cm)


Histologic Features

  • Tumor is composed of nodules, nests, &/or infiltrative cords

    • Overlying ulceration and serum crusting often present in large tumors

  • Proliferation of small basaloid cells with peripheral palisading

  • Stromal retraction artifact

    • Between tumor cells and stroma

  • Mucinous material may be present

  • Numerous mitotic and apoptotic figures present

  • Cells show enlarged hyperchromatic nuclei with inconspicuous or small nucleoli and scant eosinophilic cytoplasm


  • Superficial-multicentric: Superficial nests attached to epidermis separated by areas of uninvolved epidermis

  • Nodular: Large, rounded predominantly dermal-based nests with prominent peripheral palisading

  • Micronodular: Predominantly dermal-based infiltrative proliferation of small nests

  • Infiltrative: Small cords and nests, often deeply invasive

  • Desmoplastic/sclerosing/morpheaform: Infiltrative strands and nests associated with dense sclerotic stroma

  • Infundibulocystic: Mature folliculocystic spaces containing keratinous material

  • Basosquamous/metatypical: Prominent areas of squamous differentiation (may mimic squamous cell carcinoma [SCC]), less peripheral palisading present

  • Fibroepithelioma of Pinkus: Numerous small, anastomosing cords of basaloid cells attached to the epidermis

  • Rare variants include adenoid, clear cell, signet ring cell, plasmacytoid/myoepithelial, and BCC with neuroendocrine differentiation

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Jul 8, 2016 | Posted by in PATHOLOGY & LABORATORY MEDICINE | Comments Off on Basal Cell Carcinoma

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